<!DOCTYPE html>
<html>
	<head>
		<meta charset="utf-8">
		<title></title>
	</head>
	<body>
		<style type="text/css">
			table tr td{
				width: 70px;
				height: 30px;
			}
			table tr{
				text-align: center;
			}
		</style>
		<table border="" cellspacing="0" align="center">
		
					<tr>
						<td colspan="2">姓名</td>
						<td colspan="2"></td>
						<td colspan="2">曾用名</td>
						<td colspan="2"></td>
						<td colspan="2">出生年月</td>
						<td colspan="2"></td>
						<td rowspan="3" colspan="2">相片</td>
						<td rowspan="3" colspan="2"></td>
					</tr>
					<tr>
						<td colspan="2">性别</td>
						<td colspan="2"></td>
						<td colspan="2">民族</td>
						<td colspan="2"></td>
						<td colspan="2">政治面貌</td>
						<td colspan="2"></td>
					</tr>
					<tr>
						<td colspan="2">年龄</td>
						<td colspan="2"></td>
						<td colspan="2">籍贯</td>
						<td colspan="2"></td>
						<td colspan="2">身体状况</td>
						<td colspan="2"></td>
					</tr>
					<tr>
						<td colspan="2" rowspan="2">基本情况</td>
						<td colspan="2">毕业学校</td>
						<td colspan="12"></td>
					</tr>
					<tr>
						<td colspan="2">家庭住址</td>
						<td colspan="12"></td>
					</tr>
					<tr>
						<td colspan="2" rowspan="6">成绩</td>
						<td colspan="2" rowspan="2">第一学期</td>
						<td colspan="2" rowspan="2">第二学期</td>
						<td colspan="2" rowspan="2">第三学期</td>
						<td colspan="2" rowspan="2">第四学期</td>
						<td colspan="2" rowspan="2">第五学期</td>
						<td colspan="2" rowspan="2">第六学期</td>
						<td colspan="2" rowspan="2">毕业设计</td>
					</tr>
					<tr></tr>
					<tr>
						<td></td>
						<td></td>
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						<td></td>
						<td></td>
						<td></td>
						<td></td>
						<td></td>
						<td></td>
						<td></td>
						<td rowspan="4" colspan="2">实习</td>
						<td colspan="2" rowspan="2"></td>
					</tr>
					<tr>
						<td></td>
						<td></td>
						<td></td>
						<td></td>
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					</tr>
					<tr>
						<td></td>
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						<td></td>
						<td></td>
						<td></td>
						<td></td>
						<td colspan="2" rowspan="2"></td>
					</tr>
					<tr>
						<td></td>
						<td></td>
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						<td></td>
						<td></td>
					</tr>
					<tr>
						<td colspan="3" rowspan="4">何时何地受过何种处罚</td>
						<td rowspan="4" colspan="6"></td>
						<td rowspan="4" colspan="4">何时何地受过何种奖励</td>
						<td rowspan="4" colspan="3"></td>
					</tr>
					<tr></tr>
					<tr></tr>
					<tr></tr>
					<tr>
						<td rowspan="4" colspan="2">备注</td>
						<td rowspan="4" colspan="14">
							（1）一律用钢笔填写，字迹要端正、清楚。<br />
							（2）内容要具体、真实。
							</td>
					</tr>
					<tr></tr>
					<tr></tr>
					<tr></tr>
	</body>
</html>
